<meta charset="utf-8">
<div id="store-basics-pill-div" class="well" >
	<form enctype="multipart/form-data" method="POST" action="@{EatAtSeatApp.saveStore()}" id='storeFormId'>
		<input type="hidden" name="store.id" id="storeIdId"> 
		<img id="storePictureId" src="http://placehold.it/100x100" alt="" style="margin-bottom: 10px; width: 100px; height: 100px">
		<input type="file" class="span6" name="picture">
		<input type="text" placeholder="Name" class="span12" name="store.name" id="storeNameId"> 
		<input type="text" placeholder="Address" class="span12" name="store.address.address"  id="storeAddressId"> 
		<input type="text" placeholder="City" class="span9" name="store.address.city" id="storeCityId"> 
		<input type="text" placeholder="State/Province/Region" class="span6" name="store.address.state" id="storeStateId"> 
		<input type="text" placeholder="Zip" class="span6" name="store.address.zip" id="storeZipId"> 
		<input type="text" placeholder="Country" class="span9" id="storeCountryId">
		<input type="text" placeholder="Phone" class="span6" id="storePhoneId">
		<button id="storeSaveButton" type="submit" class="btn btn-primary">Save</button>
	</form>
</div>